Over the years the country has seen a growing incidence of expectant mothers undergoing caesarean section, which is seemingly becoming a common child birth methodology.  What explains this growing preference to c-section?  

A caesarean section is a type of birth done by a surgical incision in the abdomen and uterus to deliver a baby or babies safely when a vaginal birth is not considered a safe route. The current caesarean rate at Mulago government hospital is 23% annually. This is nearly the same trend at Kawolo Hospital which is between 15%-22%. Most women do not choose whether to go caesarean section or the natural vaginal birth route during labour. In most cases the decision is taken by the doctors and the husband when other options have failed.

Dr Musa Sekikubo, an obstetrician and gynaecologist at Mulago Hospital, says there are two types of C-section; the emergency which is not planned for and planned c-section that is done on women under pre- current condition. There are conditions classified as pre-current and non-recurrent, which require a woman to undergo c-section. Pre-current conditions are habitual and they occur when the mother’s pelvis is small and in cases where the mother has delivered more than once with c-section. Non-recurrent conditions occur when the placenta comes out first, blood pressure is high or when the baby is overweight at 4.5kgs and above. 

Dr Musa says that at Mulago Hospital’s private wing women who undergo c-section pay between Shs1.2-1.4 million. Those who deliver by natural method are charged between Shs300,000–450,000. Women who deliver from the general ward are not charged no matter the birth method. Mulago delivers more babies than any other hospital (about 60-70 babies per day) in Uganda.

Dr Karuhanga Vincent of Friends Polyclinic says caesarean section should only be conducted if the life of the mother and baby is at risk or if the baby is too big to pass through the birth canal (vagina). C-section is also usually preferred when the mother has high blood pressure, in absence of contractions and in cases of HIV-positive mothers to prevent transmission of the virus to the baby.

These are purely medical reasons. However there are non-medical medical reasons why women prefer c-section. Many women opt for c-section even when it has not been recommended by a doctor. This is common among elite women or those with moderate formal education. Why? Many educated women think c-section is less tedious than pushing the baby through the natural birth canal. Dr Karuhanga says the fear that their birth canals will become wider, the fear to push, desire to avoid labour pain and the need to maintain the elasticity of their birth canals have encouraged many educated women to prefer c-section. However he points out that c-section may lead to death through anesthesia or cardiac arrest during the operation. He says that in most cases the baby is born weak and may even die. There is also the risk of failure of the wound to heal properly or leaving behind bad scars. Sometimes the uterus may fail to return to original size.

Dr Karuhanga advised women to do exercises such as kegel, yoga, and pelvic floor exercise which can help them maintain their pelvic tightness. With such exercises women do not need to fear losing their tightness to traditional delivery method.

Although in some cases c-section is the best method, it has disturbing effects on the mother. Women who are operated upon stay longer in hospital (3-4 days instead of the usual 1-2 days) than those who deliver by the natural method of “pushing.” Besides the longer admission period, Dr Musa says the surgery itself is expensive and poses higher risks of contracting infections. It’s painful and most women have difficulty in walking which is not the case with the natural birth method.

Because of the foregoing, Dr Othman Kakaire, a consultant at Mulago’s Department of Obstetrics and Gynaecology, the c-section should not been looked at as a pre-condition for child birth. Rather it should be looked at as a solution. In the past, he says, women who failed to push the baby out would be left to die or they would produce exhausted or dead babies. He says c-section can prevent still births caused by the mother’s fatigue, complications or failure to push the baby. He says c-section accounts for 1 percent of child births in the country, which is far below the required 5–15 percent. He speculated that the application of c-section will increase due to improvements in technology.

However, Dr Kakaire advises that in order to minimise or curb the incidence of c-section among pregnant mothers due to the associated complications, children should be immunised early, fed on balanced diet and girls should give birth when they are mature and their bones have developed fully. Seeking antenatal care and delivering under supervision of trained personnel are very important.

Is c-section driven by monetary gain?

For every operation, the doctor gets a certain share of the amount charged. Some people have said this monetary gain encourages doctors to recommend expectant mothers for c-section even when it’s unnecessary. However, Dr Kakaire dismisses the claims. He says that c-section instead exposes doctors to many risks like HIV/AIDS infection. He says every doctor would love every woman to deliver by natural method but some times circumstances dictate that a c-section be applied.

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